Eyes and Kidneys: The Silent Complications of Diabetes
Regular screening, prevention, and early treatment are therefore essential to slow disease progression and reduce the risk of permanent organ damage.
Diabetic Retinopathy
Diabetic retinopathy occurs when persistently high blood glucose damages the small blood vessels in the retina, the light-sensitive tissue at the back of the eye.
The condition may develop gradually without noticeable symptoms during its early stages.
Non-Proliferative Diabetic Retinopathy
Non-proliferative diabetic retinopathy, or NPDR, is the earlier stage of the disease. It may be classified as:
๐ Mild
๐ Moderate
๐ Severe
During this stage, retinal blood vessels may weaken, leak fluid, or develop small areas of bleeding.
Proliferative Diabetic Retinopathy
Proliferative diabetic retinopathy, or PDR, is a more advanced form of the condition.
Abnormal new blood vessels grow on the retina. These vessels are fragile and may cause:
๐ Bleeding into the vitreous gel inside the eye
๐ Bleeding in front of the retina
๐ Scar tissue formation
๐ Retinal detachment
๐ Severe or permanent vision loss
Recommended Retinal Screening
People with Type 1 Diabetes
People with type 1 diabetes should generally receive a comprehensive retinal examination within five years of diagnosis.
Further examinations should be performed according to the ophthalmologist’s recommendations or at least once a year.
People with Type 2 Diabetes
People with type 2 diabetes should receive a retinal examination promptly after diagnosis because elevated blood glucose may have been present for some time before diabetes was detected.
Follow-up examinations should be performed according to the doctor’s recommendations or at least annually.
Pregnant Women with Diabetes
Women who already have diabetes and become pregnant should receive a retinal examination:
๐ As soon as pregnancy is confirmed
๐ Within the first three months of pregnancy
๐ At additional intervals recommended by an ophthalmologist
Pregnancy may accelerate diabetic retinopathy in some patients, making close monitoring particularly important.
Preventing and Managing Diabetic Eye Disease
Control Blood Glucose
Keeping blood glucose as close to the individual target range as safely possible can reduce the risk of developing retinopathy and slow its progression.
General targets may include:
๐ Blood glucose before meals below approximately 130 mg/dL
๐ Blood glucose after meals below approximately 180 mg/dL
Targets should be personalised according to age, health conditions, pregnancy, medication, and the risk of hypoglycaemia.
Control Blood Pressure
Blood pressure should be measured regularly and maintained within the target recommended by the doctor.
A commonly used target is approximately below 130/80 mmHg, although the most appropriate goal may vary between patients.
Manage Blood Lipids
Abnormal cholesterol levels may contribute to blood-vessel damage.
A commonly referenced LDL cholesterol target is below 100 mg/dL, but people with cardiovascular disease or a very high risk may require a lower individual target.
Receive Treatment at the Appropriate Time
Depending on the stage of diabetic retinopathy, treatment may include:
๐ Laser therapy
๐ Medication injected into the eye
๐ Surgery for severe bleeding or retinal detachment
Receiving treatment at the appropriate stage may help prevent or reduce vision loss.
Warning Signs That Require Medical Attention
People with diabetes should contact an eye doctor promptly if they experience:
๐ Blurred or reduced vision
๐ Sudden changes in vision
๐ Dark spots or floating objects in the visual field
๐ Flashes of light
๐ A dark curtain or shadow covering part of the vision
๐ Sudden loss of vision
Diabetic retinopathy may remain symptomless until it becomes advanced, so normal vision does not mean that screening can be skipped.
Diabetic Kidney Disease
Diabetic kidney disease develops when high blood glucose gradually damages the small blood vessels and filtering structures within the kidneys.
Its development and progression are associated with:
๐ Poor blood glucose control
๐ High blood pressure
๐ Genetic factors
๐ The duration of diabetes
๐ Smoking
๐ Abnormal cholesterol levels
In its early stages, diabetic kidney disease may not cause any noticeable symptoms.
Detecting Diabetic Kidney Disease
One of the earliest signs is an abnormal amount of albumin, a type of protein, in the urine. This condition is known as albuminuria.
Kidney screening may include:
๐ A urine albumin test
๐ A urine albumin-to-creatinine ratio
๐ Blood creatinine testing
๐ Estimated glomerular filtration rate, or eGFR
Together, these tests help assess whether the kidneys are leaking protein and how effectively they are filtering the blood.
Recommended Kidney Screening
People with diabetes should receive kidney screening according to their doctor’s recommendations or at least once a year.
More frequent monitoring may be necessary for patients who already have:
๐ Albumin in the urine
๐ Reduced kidney function
๐ High blood pressure
๐ Cardiovascular disease
๐ Rapid changes in kidney test results
Preventing and Managing Diabetic Kidney Disease
Before Protein Is Detected in the Urine
When no albumin is detected, the main goal is to maintain blood glucose as close to the target range as safely possible.
Other important measures include:
๐ Controlling blood pressure
๐ Managing cholesterol
๐ Avoiding smoking
๐ Maintaining a healthy body weight
๐ Attending regular kidney screening
When Protein Is Detected in the Urine
When albuminuria is present, careful control of both blood glucose and blood pressure becomes particularly important.
A blood pressure target of approximately below 130/80 mmHg may be recommended for some patients, depending on their overall condition.
The doctor may also prescribe medication to protect kidney function and reduce protein leakage when clinically appropriate.
Screening Findings at Bangkok Hospital Phuket
According to screening statistics provided for patients with diabetes receiving care at Bangkok Hospital Phuket:
๐ 27.74% were found to have eye abnormalities.
๐ 21.74% were found to have kidney abnormalities.
These findings highlight how frequently diabetic complications may be detected during screening, even when patients do not yet notice obvious symptoms.
Protecting the Eyes and Kidneys
Diabetic eye and kidney disease are often described as silent complications because they may progress without clear warning signs.
People with diabetes should:
๐ Maintain good blood glucose control.
๐ Monitor blood pressure and cholesterol.
๐ Receive a retinal examination at the recommended intervals.
๐ Complete urine and kidney-function tests regularly.
๐ Avoid smoking.
๐ Take prescribed medication consistently.
๐ Seek medical attention promptly when vision or urinary symptoms change.
Early screening and appropriate treatment can help preserve vision, protect kidney function, and reduce the risk of disability and other serious complications.
Reference :
Independent Writer
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